Unnecessary laryngeal irradiation in the IMRT era.

PURPOSE The purpose of this review is to address the issue of unnecessary irradiation of the normal larynx. METHODS We performed a literature review and dosimetry evaluation of intensity modulated radiotheraphy (IMRT) techniques. RESULTS Data suggest that matching conventional parallel opposed photon fields through adenopathy is a reasonable alternative to the common practice of unnecessarily irradiating the normal larynx to high doses. The dosimetry evaluation demonstrates that the laryngeal dose is much higher when the entire neck is included in the IMRT field as opposed to using a standard anterior low-neck field below the level of the thyroid notch. CONCLUSIONS Lateral opposed fields should not be extended to include the larynx to avoid matching fields through adenopathy. IMRT fields should not include the normal larynx when the laryngeal dose would be substantially lower with a technique that shields the larynx in an anterior low-neck field.